微创泌尿外科杂志

目的：探讨机器人肾部分切除联合静脉瘤栓取出术治疗肾血管平滑肌脂肪瘤合并静脉瘤栓的安全性及可行性。方法：回顾性分析2018年6月至2025年3月在解放军总医院泌尿外科医学部接受机器人肾部分切除联合静脉瘤栓取出术的5例合并静脉瘤栓的肾血管平滑肌脂肪瘤患者的临床资料。其中男性1例，女性4例，中位年龄42(34～61)岁。肾脏肿瘤均位于右侧，肿瘤原发灶中位最大径2.1(0.5～5.7)cm。静脉瘤栓根据“301分级系统”进行分类：其中0级1例，Ⅰ级1例，Ⅱ级3例。结果：5例患者手术均顺利完成，无中转开放，无中转根治性肾切除术。中位手术时间145(95～175)min，中位失血量300(50～600)ml，中位右肾动脉阻断时间27(20～31)min，中位下腔静脉阻断时间7(3～20)min，中位术后住院时间5(4～7)d。5例患者均未发生围手术期严重并发症（Clavien-Dindo分级Ⅲ～Ⅴ级），术后无血尿、尿瘘。5例患者术后病理均为肾血管平滑肌脂肪瘤。患者术后1 d、1个月、3个月的肾功能均恢复至基线水平，随访未见肿瘤复发。结论：初步验证机器人肾部分切除联合静脉瘤栓取出术治疗肾血管平滑肌脂肪瘤合并静脉瘤栓是安全、可行的，该术式能够实现更好的肾功能保留。

Objective: To explore the safety and feasibility of robotic partial nephrectomy combined with venous thrombus extraction in the treatment of renal angiomyolipoma(RAML) complicated with venous thrombus. Methods: A retrospective analysis was performed on the clinical data of 5 patients with RAML complicated with venous thrombus who underwent robot-assisted nephron-sparing surgery with thrombectomy in Senior Department of Urology, PLA General Hospital between June 2018 and March 2025. One patient was male and 4 were female, with a median age of 42(range:34-61) years.All renal tumors were located on the right side, with a median maximum diameter of the primary tumor of 2.1(range:0.5-5.7)cm. Venous thrombi were classified according to the "301 Classification System" : 1 case of grade 0, 1 case of grade I, and 3 cases of grade II. Results: All 5 patients successfully completed the surgery without conversion to open surgery or radical nephrectomy. The median operation time was 145(range:95-175) minutes, median blood loss was 300(range:50-600)mL, median right renal artery clamping time was 27(range:20-31) minutes, median inferior vena cava clamping time was 7(range:3-20) minutes, and median postoperative hospital stay was 5(range:4-7) days. No perioperative severe complications(ClavienDindo grade Ⅲ-Ⅴ) occurred in any of the 5 patients, and there was no postoperative hematuria or urinary fistula. Postoperative pathology confirmed RAML in all 5 patients. The renal function of the patients recovered to the baseline level at 1 day, 1 month, and 3 months after surgery, and no tumor recurrence was observed during follow-up. Conclusion: This study initially verifies that robotic partial nephrectomy combined with venous thrombus extraction is safe and feasible for the treatment of RAML complicated with venous thrombus, and this surgical approach can achieve better renal function preservation.